 http:/www.smartspeechtherapy.com/shop/fetal-alcohol-spectrum-disorders-assessment-and-treatment-bundle

Posted on June 20, 2014January 5, 2022 by Tatyana Elleseff — Leave a comment

What is ND-PAE and how is it Related to FASD?

The DSM-5 was released in May 2013 and with it came a revision of criteria for the diagnosis and classification of many psychiatric disorders. Among them a new proposed criteria was included relevant to alcohol related deficits in children, which is Neurobehavioral Disorder Associated With Prenatal Alcohol Exposure (ND-PAE) (DSM-5, pgs 798-801). This proposed criteria was included in order to better serve the complex mental health needs of individuals diagnosed with alcohol related deficits, which the previous diagnosis of 760.71 – Alcohol affecting fetus or newborn via placenta or breast milk was unable to adequately capture. Continue reading What is ND-PAE and how is it Related to FASD?

Posted on June 4, 2014January 5, 2022 by Tatyana Elleseff — 3 Comments

Why Developmental History Matters: On the Importance of Background Information in Speech-Language Assessments

Lately I’ve been seeing quite a few speech language therapy reports with minimal information about the child in the background history section of the report. Similarly, I’ve encountered numerous SLPs seeking advice and guidance relevant to the assessment and treatment of difficult cases who were often at a loss when asked about specific aspects of their client’s background family history in order to assist them better. They’ve never delved into it beyond a few surface details! Continue reading Why Developmental History Matters: On the Importance of Background Information in Speech-Language Assessments

Posted on February 6, 2015January 5, 2022 by Tatyana Elleseff — 4 Comments

Simplifying Testing Results to Understand the Student’s Difficulties

Oftentimes explaining testing results in the form of standard scores, percentiles, and charts is labor-intensive for the SLP and confusing for parents and ancillary professionals. Furthermore, just because you show testing results does not always ensure that the ramifications of testing are fully understood, especially when it comes to performance of high functioning students with deficits in isolated areas, which may significantly impact the student’s functioning in social and academic settings.

So finding an effective method of sharing testing results was fraught with difficulties until recently. In early January, I attended a Sarah Ward executive function conference, where Sarah shared one of her tricks of sharing testing results. She used a picture of a bell curve and inserted testing results into it. So it looked a little similar to the picture I have below:

As you can see the student’s listening comprehension and expressive language performance fell in the average range as denoted on the bottom of the picture. In contrast, the student’s problem solving and social pragmatic testing abilities fell in the below average range as is denoted by both a red bar as well as the caption underneath the picture.

It is a visually simple way to see what areas need to be worked on in one snapshot.

Charts in Action: Students with Social Skills Deficits

This system is even more effective for displaying testing results of higher functioning students with select deficit areas. To illustrate, I recently performed a comprehensive language assessment on a 12-year-old adolescent with suspected ASD. The student had a superior IQ, excellent vocabulary, and phenomenal memory.

When tested in school setting she did not qualify to receive language intervention. However, her comprehensive language testing with me showed a number of disparities. While the majority of her testing fell in the above average and superior range, in a number of testing areas she performed within average and below average range (combined SLP, ED, and Psych. testing results below).

When one looked at the student’s overall testing results, they clearly indicated cumulative performance in the average range of functioning. However, after I plotted all of her results on the bell curve her deficit areas became very clearly apparent and her testing discrepancy clearly indicated that intervention in select areas of functioning was needed.

So even though select scores were clearly in the average range of functioning on the bell curve, they were actually BELOW AVERAGE for this student as compared to significant strengths in all other areas.

Many would argue with me pointing out that scores in the average range mean average range. The student doesn’t qualify – end of story! So let me explain the above scores in REAL-LIFE terms.

Why Students with Average Scores May Still Require Services

This particular student was referred for a social pragmatic evaluation due to behavioral difficulties in the classroom which included verbal outbursts, difficulty engaging in cooperative group work and verbal confrontations with classmates.

Interactions with the student revealed an engaging adolescent who preferred the company of adults and was very likable. However, throughout testing she made comments indicating cognizance that she was not accepted by typically developing peers. She frustratedly stated that she “doesn’t get” peers, is not interested in the “typical” experiences and has “nothing in common” with peers her age because she “misses the point” of their verbal interchanges.

Due to her exceptional performance on standardized testing, many school-based professionals believed that because she did so well well she did not have any “true” social learning deficits. In contrast the student’s peer group was able to see her social differences with very little effort. In school, the student did not qualify for social pragmatic language therapy, on the basis of her challenges being perceived as too “mild” to merit services, however her social deficits were NOT mild as judged by her peers. They were only mild as compared to individuals with severe social learning challenges. Without appropriate intervention, these difficulties would continue to pervasively impact her academic and social performance, as well as affect future employment and relationship status.

So this is why I now love plotting scores on the bell curve for parents and professionals. A simple picture clearly shows the significance of score distribution, the deficits areas in need of intervention, and is literally worth a 1000 words!

Helpful Resources Related to Social Pragmatic Language Overview, Assessment and Remediation:

Posted on August 10, 2013January 5, 2022 by Tatyana Elleseff — Leave a comment

SLPs Blogging About Research: August Edition -FASD

This month I am joining the ranks of bloggers who are blogging about research related to the field of speech pathology. Click here for more details.

Today I will be reviewing a recently published article in The Journal of Neuroscience on the topic of brain development in children with Fetal Alcohol Spectrum Disorders (FASD), one of my areas of specialty in speech pathology.

Title: Longitudinal MRI Reveals Altered Trajectory of Brain Development during Childhood and Adolescence in Fetal Alcohol Spectrum Disorder

Purpose: Canadian researchers performed advanced MRI brain scans of 17 children with FASD between 5 and 15 years of age and compared them to the scans of 27 children without FASD. Each participant underwent 2-3 scans and each scan took place 2-4 years apart. The multiple scan component over a period of time is what made this research study so unique because no other FASD related study had done it before.

Aim of the study: To better understand how brain abnormalities evolve during key developmental periods of behavioral and cognitive progression via longitudinal examination of within-subject changes in white brain matter (Diffusion Tensor Imaging – DTI) ) in FASD during childhood and adolescence.

Subjects: Experimental subjects had a variety of FASD diagnoses which included fetal alcohol syndrome (FAS), partial FAS (pFAS), static encephalopathy alcohol exposed (SE:AE), neurobehavioral disorder alcohol exposed (NBD:AE), as well as alcohol related neurobehavioral disorder (ARND). Given the small study size the researchers combined all sub diagnoses into one FASD group for statistical analysis.

In addition to the imaging studies, FASD subjects underwent about ∼1.5 h of cognitive testing at each scan, administered by a trained research assistant. The test battery included:

Woodcock Johnson Quantitative Concepts 18A&B (mathematics)
Woodcock Reading Mastery Test-Revised (WRMT-R) Word ID
Comprehensive Expressive and Receptive Vocabulary Test (CREVT)
Working Memory Test Battery for Children (WMTB-C)
Behavior Rating Inventory of Executive Function (BRIEF) parent form
NEPSYI/II (auditory attention and response set; memory for names, narrative memory; arrows).

9/17 participants in the FASD group were also administered the Wide Range Intelligence Test (WRIT) at scan 2.

Control subjects were screened for psychiatric and neurological impairments. Their caregivers were also contacted retrospectively and asked to estimate in utero alcohol exposure for their child. Of the 21 control subject caregivers who were reached, 14/21 reported no exposure, 2/21 unknown, and 5/21 reported minimal alcohol exposure (range: 1–3 drinks; average of two drinks total during pregnancy). Control subjects did not undergo a full battery of cognitive testing, but were administered WRMT-R Word ID at each scan.

Summary of results: The FASD group performed significantly below the controls on most of the academic, cognitive, and executive function measures despite average IQ scores in 53% of the FASD sample. According to one of the coauthors, Sarah Treit, “longitudinal increases in raw cognitive scores (albeit without changes in age-corrected standard scores) suggest that the FASD group made cognitive gains at a typical rate with age, while still performing below average”. For those of us who work with this population these findings are very typical.

Imaging studies revealed that over time subjects in the control group presented with marked increases in brain volume and white matter – growth which was lacking in subjects with FASD. Furthermore, children with FASD who demonstrated the greatest changes in white matter development (on scans) also made the greatest reading gains. Children with the most severe FASD showed the greatest diffusion changes in white matter brain wiring and less overall brain volume.

Implications: “This study suggests alcohol-induced injury with FASD isn’t static – those with FASD have altered brain development, they aren’t developing at the same rate as those without the disorder.” So not only does the brain altering damage exists in children with FASD at birth, but it also continues to negatively affect brain development through childhood and at least through adolescence.

Given these findings, it is very important for SLPs to perform detailed and comprehensive language assessments and engage in targeted treatment planning for these children in order to provide them with specialized individualized services which are based on their rate of development.

Posted on May 23, 2015January 5, 2022 by Tatyana Elleseff — 3 Comments

Teaching “Insight” to students with language, social communication, and executive functions impairments

One common difficulty our “higher functioning” (refers to subjective notion of ‘perceived’ functioning in school setting only) language impaired students with social communication and executive function difficulties present with – is lack of insight into own strengths and weaknesses.

Yet insight is a very important skill, which most typically developing students exhibit without consciously thinking about it. Having insight allows students to review work for errors, compensate for any perceived weaknesses effectively, and succeed with efficient juggling of academic workload.

In contrast, lack of insight in students with language deficits further compounds their difficulties, as they lack realization into own weaknesses and as a result are unable to effectively compensate for them.

That is why I started to explicitly teach the students on my caseload in both psychiatric hospital and private practice the concept of insight.

Now some of you may have some legitimate concerns. You may ask: “How can one teach such an abstract concept to students who are already impaired in their comprehension of language?” The answer to that is – I teach this concept through a series of concrete steps as well as through the introduction of abstract definitions, simplified for the purpose of my sessions into concrete terms.

Furthermore, it is important to understand that the acquisition of “insight” cannot be accomplished in one or even several sessions. Rather after this concept is introduced and the related vocabulary has been ‘internalized’ by the student, thematic therapy sessions can be used to continue the acquisition of “insight” for months and even years to come.

How do we begin?

When I first started teaching this concept I used to explain the terminology related to “insight” verbally to students. However, as my own ‘insight’ developed in response to the students’ performance, I created a product to assist them with the acquisition of insight (See HERE).

Intended Audiences:

Clients with Language Impairments
Clients with Social Pragmatic Language Difficulties
Clients with Executive Function Difficulties
Clients with Psychiatric Impairments
- ODD, ADHD, MD, Anxiety, Depression, etc.
Clients with Autism Spectrum Disorders
Clients with Nonverbal Learning Disability
Clients with Fetal Alcohol Spectrum Disorders
Adult and pediatric post-Traumatic Brain Injury (TBI) clients
Clients with right-side CVA Damage

This thematic 10 page packet targets the development of “insight” in students with average IQ, 8+ years of age, presenting with social pragmatic and executive function difficulties.

The packet contains 1 page text explaining the concept of insight to students.

It also contains 11 Tier II vocabulary words relevant to the discussion of insight and their simplified definitions. The words were selected based on course curriculum standards for several grade levels (fourth through seventh) due to their wide usage in a variety of subjects (social studies, science, math, etc.)

Language activities in this packet include:

Explaining definitions
Answering open-ended comprehension questions
Sentence construction activity
Crossword puzzle
Two morphological awareness activities
- Define prefixes and suffixes
- Change word meanings by adding prefixes and suffixes to words
Self-reflection page in written format contains questions for students to assist them with judging their own strengths and weaknesses related to academic performance

And now a few words regarding the lesson structure…

I introduce the concept of “insight” to clients by writing down the word and asking them to identify its parts: ‘in‘ and ‘sight‘. Depending on the student’s level of abilities I either get to the students to explain it to me or explain it myself that it is a compound word made up of two other words.

I then ask the students to interpret what the word could potentially mean. After I hear their responses I either confirm the correct one or end up explaining that this word refers to “looking into one’s brain” for answers related to how well someone understands information.

I have the students read the text located on the first page of my packet going over the concept of insight and some of its associated vocabulary words. I ask the students to tell me the main idea of each paragraph as well as answer questions regarding supporting text details.

Once I am confident that the students have a fairly good grasp of the presented text I move on to the definitions page. There are actually two definition pages in the lesson: one at the beginning and one at the end of the packet. The first definitions page also contains word meaning and what parts of speech the definitions belong to. The definition page at the end of the packet contains only the targeted words. It is now the students responsibility to write down the definition of all the vocabulary words and phrases in order for me to see how well they remember the meanings of pertinent words.

The packet also includes comprehension questions, a section on sentence construction several morphological awareness activities, a crossword puzzle and a self-reflection page.

The final activity in the packet requires the student to judge their own work performance during this activity. I ask students questions such as:

How do you think you did on this task?
How do you know you did ________?
How can you prove to me you understood ________?

If a student responds “I know I did well because I understood everything”, I typically ask them to prove their comprehension to me, verbally. Here the goal is to have the student provide concrete verbal examples supporting their insight of their performance.

This may include statements such as:

I know I did well because you said: “Nice Work!”
I know I did well because you didn’t correct me too much
I know I did well because you kept smiling and showed me thumbs up as I was talking

As mentioned above this activity is only the beginning. After I ensure that the students have a decent grasp of this concept I continue working on it indirectly by having the students continuously judge their own performance on a variety of other therapy related activities and assignments.

You can find the complete packet on teaching “insight” in my online store (HERE). Also, stay tuned for Part II of this series, which will describe how to continue solidifying the concept of “insight” in the context of therapy sessions for students with social pragmatic and executive function deficits.

Helpful Smart Speech Resources:

Posted on April 9, 2015January 12, 2022 by Tatyana Elleseff — 3 Comments

Thematic Language Intervention with Language Impaired Children Using Nonfiction Texts

In the past a number of my SLP colleague bloggers (Communication Station, Twin Sisters SLPs, Practical AAC, etc.) wrote posts regarding the use of thematic texts for language intervention purposes. They discussed implementation of fictional texts such as the use of children’s books and fairy tales to target linguistic goals such as vocabulary knowledge in use, sentence formulation, answering WH questions, as well as story recall and production.

Today I would like to supplement those posts with information regarding the implementation of intervention based on thematic nonfiction texts to further improve language abilities of children with language difficulties.

First, here’s why the use of nonfiction texts in language intervention is important. While narrative texts have high familiarity for children due to preexisting, background knowledge, familiar vocabulary, repetitive themes, etc. nonfiction texts are far more difficult to comprehend. It typically contains unknown concepts and vocabulary, which is then used in the text multiple times. Therefore lack of knowledge of these concepts and related vocabulary will result in lack of text comprehension. According to Duke (2013) half of all the primary read-alouds should be informational text. It will allow students to build up knowledge and the necessary academic vocabulary to effectively participate and partake from the curriculum.

So what type of nonfiction materials can be used for language intervention purposes. While there is a rich variety of sources available, I have had great success using Let’s Read and Find Out Stage 1 and 2 Science Series with clients with varying degrees of language impairment.

Here’s are just a few reasons why I like to use this series.

They can be implemented by parents and professionals alike for different purposes with equal effectiveness.
They can be implemented with children fairly early beginning with preschool on-wards
The can be used with the following pediatric populations:
- Language Disordered Children
- Children with learning disabilities and low IQ
- Children with developmental disorders and genetic syndromes (Fragile X, Down Syndrome, Autism, etc.)
- Children with Fetal Alcohol Spectrum Disorders
- Internationally adopted children with language impairment
- Bilingual children with language impairment
- Children with dyslexia and reading disabilities
- Children with psychiatric Impairments
The books are readily available online (Barnes & Noble, Amazon, etc.) and in stores.
They are relatively inexpensive (individual books cost about $5-6).
Parents or professionals who want to continuously use them seasonally can purchase them in bulk at a significantly cheaper price from select distributors (Source: rainbowresource.com)
They are highly thematic, contain terrific visual support, and are surprisingly versatile, with information on topics ranging from animal habitats and life cycles to natural disasters and space.
They contain subject-relevant vocabulary words that the students are likely to use in the future over and over again (Stahl & Fairbanks, 1986).
The words are already pre-grouped in semantic clusters which create schemes (mental representations) for the students (Marzano & Marzano, 1988).

For example, the above books on weather and seasons contain information on:

1. Front Formations
2. Water Cycle
3. High & Low Pressure Systems

Let’s look at the vocabulary words from Flash, Crash, Rumble, and Roll (see detailed lesson plan HERE). (Source: ReadWorks):

Word: water vapor
Context: Steam from a hot soup is water vapor.

Word: expands
Context: The hot air expands and pops the balloon.

Word: atmosphere
Context: The atmosphere is the air that covers the Earth.

Word: forecast
Context: The forecast had a lot to tell us about the storm.

Word: condense
Context: steam in the air condenses to form water drops.

These books are not just great for increasing academic vocabulary knowledge and use. They are great for teaching sequencing skills (e.g., life cycles), critical thinking skills (e.g., What do animals need to do in the winter to survive?), compare and contrast skills (e.g., what is the difference between hatching and molting?) and much, much, more!

So why is use of nonfiction texts important for strengthening vocabulary knowledge and words in language impaired children?

As I noted in my previous post on effective vocabulary instruction (HERE): “teachers with many struggling children often significantly reduce the quality of their own vocabulary unconsciously to ensure understanding” (Excerpts from Anita Archer’s Interview with Advance for SLPs).

The same goes for SLPs and parents. Many of them are under misperception that if they teach complex subject-related words like “metamorphosis” or “vaporization” to children with significant language impairments or developmental disabilities that these students will not understand them and will not benefit from learning them.

However, that is not the case! These students will still significantly benefit from learning these words, it will simply take them longer periods of practice to retain them!

By simplifying our explanations, minimizing verbiage and emphasizing the visuals, the books can be successfully adapted for use with children with severe language impairments. I have had parents observe my intervention sessions using these books and then successfully use them in the home with their children by reviewing the information and reinforcing newly learned vocabulary knowledge.

Here are just a few examples of prompts I use in treatment with more severely affected language-impaired children:

What do you see in this picture?
This is a _____ Can you say _____
What do you know about _____?
What do you think is happening? Why?
What do you think they are doing? Why?
Let’s make up a sentence with __________ (this word)
You can say ____ or you can say ______ (teaching synonyms)
What would be the opposite of _______? (teaching antonyms)
Do you know that _____(this word) has 2 meanings
- 1st meaning
- 2nd meaning
How do ____ and _____ go together?

Here are the questions related to Sequencing of Processes (Life Cycle, Water Cycle, etc.)

What happened first?
What happened second?
What happened next?
What happened after that?
What happened last?

As the child advances his/her skills I attempt to engage them in more complex book interactions

Compare and contrast items
(e.g. objects/people/animals)
Make predictions and inferences about will happen next?
Why is this book important?

“Picture walks” (flipping through the pages) of these books are also surprisingly effective for activation of the student’s background knowledge (what a student already knows about a subject). This is an important prerequisite skill needed for continued acquisition of new knowledge. It is important because “students who lack sufficient background knowledge or are unable to activate it may struggle to access, participate, and progress through the general curriculum” (Stangman, Hall & Meyer, 2004).

These book allow for :

1.Learning vocabulary words in context embedded texts with high interest visuals

2.Teaching specific content related vocabulary words directly to comprehend classroom-specific work

3.Providing multiple and repetitive exposures of vocabulary words in texts

4. Maximizing multisensory intervention when learning vocabulary to maximize gains (visual, auditory, tactile via related projects, etc.)

To summarize, children with significant language impairment often suffer from the Matthew Effect (“rich get richer, poor get poorer”), or interactions with the environment exaggerate individual differences over time

Children with good vocabulary knowledge learn more words and gain further knowledge by building of these words

Children with poor vocabulary knowledge learn less words and widen the gap between self and peers over time due to their inability to effectively meet the ever increasing academic effects of the classroom. The vocabulary problems of students who enter school with poorer limited vocabularies only worsen over time (White, Graves & Slater, 1990). We need to provide these children with all the feasible opportunities to narrow this gap and partake from the curriculum in a more similar fashion as typically developing peers.

Helpful Smart Speech Therapy Resources:

References:

Duke, N. K. (2013). Starting out: Practices to Use in K-3. Educational Leadership, 71, 40-44.

Marzano, R. J., & Marzano, J. (1988). Toward a cognitive theory of commitment and its implications for therapy. Psychotherapy in Private Practice 6(4), 69–81.

Stahl, S. A. & Fairbanks, M. M. “The Effects of Vocabulary Instruction: A Model-based Metaanalysis.” Review of Educational Research 56 (1986): 72-110.

Strangman, N., Hall, T., & Meyer, A. (2004). Background knowledge with UDL. Wakefield, MA: National Center on Accessing the General Curriculum.

White, T. G., Graves, M. F., & Slater W. H. (1990). Growth of reading vocabulary in diverse elementary schools: Decoding and word meaning. Journal of Educational Psychology, 82, 281–290.

Posted on February 10, 2015January 5, 2022 by Tatyana Elleseff — 4 Comments

What if Its More Than Just “Misbehaving”?

Frequently, I see a variation of the following scenario on many speech and language forums.

The SLP is seeing a client with speech and/or language deficits through early intervention, in the schools, or in private practice, who is having some kind of behavioral issues.

Some issues are described as mild such as calling out, hyperactivity, impulsivity, or inattention, while others are more severe and include refusal, noncompliance, or aggression such as kicking, biting, or punching.

An array of advice from well-meaning professionals immediately follows. Some behaviors may be labeled as “normal” due to the child’s age (toddler), others may be “partially excused” due to a DSM-5 diagnosis (e.g., ASD). Recommendations for reinforcement charts (not grounded in evidence) may be suggested. A call for other professionals to deal with the behaviors is frequently made (“in my setting the ______ (insert relevant professional here) deals with these behaviors and I don’t have to be involved”). Specific judgments on the child may be pronounced: “There is nothing wrong with him/her, they’re just acting out to get what they want.” Some drastic recommendations could be made: “Maybe you should stop therapy until the child’s behaviors are stabilized”.

However, several crucial factors often get overlooked. First, a system to figure out why particular set of behaviors takes place and second, whether these behaviors may be manifestations of non-behaviorally based difficulties such as medical issues, or overt/subtle linguistically based deficits.

So what are some reasons kids may present with behavioral deficits? Obviously, there could be numerous reasons: some benign while others serious, ranging from lack of structure and understanding of expectations to manifestations of psychiatric illnesses and genetic syndromes. Oftentimes the underlying issues are incredibly difficult to recognize without a differential diagnosis. In other words, we cannot claim that the child’s difficulties are “just behavior” if we have not appropriately ruled out other causes which may be contributing to the “behavior”.

Here are some possible steps which can ensure appropriate identification of the source of the child’s behavioral difficulties in cases of hidden underlying language disorders (after of course relevant learning, genetic, medical, and psychiatric issues have been ruled out).

Let’s begin by answering a few simple questions. Was a thorough language evaluation with an emphasis on the child’s social pragmatic language abilities been completed? And by thorough, I am not referring to general language tests but to a variety of formal and informal social pragmatic language testing (read more HERE).

Please note that none of the general language tests such as the Preschool Language Scale-5 (PLS-5), Comprehensive Assessment of Spoken Language (CASL-2), the Test of Language Development-4 (TOLD-4) or even the Clinical Evaluation of Language Fundamentals Tests (CELF-P2)/ (CELF-5) tap into the child’s social language competence because they do NOT directly test the child’s social language skills (e.g., CELF-5 assesses them via a parental/teachers questionnaire). Thus, many children can attain average scores on these tests yet still present with pervasive social language deficits. That is why it’s very important to thoroughly assess social pragmatic language abilities of all children (no matter what their age is) presenting with behavioral deficits.

But let’s say that the social pragmatic language abilities have been assessed and the child was found/not found to be eligible for services, meanwhile, their behavioral deficits persist, what do we do now?

The first step in establishing a behavior management system is determining the function of challenging behaviors, since we need to understand why the behavior is occurring and what is triggering it (Chandler & Dahlquist, 2006)

We can begin by performing some basic data collection with a child of any age (even with toddlers) to determine behavior functions or reasons for specific behaviors. Here are just a few limited examples:

Seeking Attention/Reward
Seeking Sensory Stimulation
Seeking Control

Most behavior functions typically tend to be positively, negatively or automatically reinforced (Bobrow, 2002). For example, in cases of positive reinforcement, the child may exhibit challenging behaviors to obtain desirable items such as toys, games, attention, etc. If the parent/teacher inadvertently supplies the child with the desired item, they are reinforcing inappropriate behaviors positively and in a way strengthening the child’s desire to repeat the experience over and over again, since it had positively worked for them before.

In contrast, negative reinforcement takes place when the child exhibits challenging behaviors to escape a negative situation and gets his way. For example, the child is being disruptive in classroom/therapy because the tasks are too challenging and is ‘rewarded’ when therapy is discontinued early or when the classroom teacher asks an aide to take the child for a walk.

Finally, automatic reinforcements occur when certain behaviors such as repetitive movements or self-injury produce an enjoyable sensation for the child, which he then repeats again to recreate the sensation.

In order to determine what reinforces the child’s challenging behaviors, we must perform repeated observations and take data on the following:

Antecedent or what triggered the child’s behavior?
- What was happening immediately before behavior occurred?
Behavior
- What type of challenging behavior/s took place as a result?
Response/Consequence
- How did you respond to behavior when it took place?

Here are just a few antecedent examples:

Therapist requested that child work on task
Child bored w/t task
Favorite task/activity taken away
Child could not obtain desired object/activity

In order to figure them out we need to collect data, prior to appropriately addressing them. After the data is collected the goals need to be prioritized based urgency/seriousness. We can also use modification techniques aimed at managing interfering behaviors. These techniques include modifications of: physical space, session structure, session materials as well as child’s behavior. As we are implementing these modifications we need to keep in mind the child’s maintaining factors or factors which contribute to the maintenance of the problem (Klein & Moses, 1999). These include: cognitive, sensorimotor, psychosocial and linguistic deficits.

We also need to choose our reward system wisely, since the most effective systems which facilitate positive change actually utilize intrinsic rewards (pride in self for own accomplishments) (Kohn, 2001). We need to teach the child positive replacement behaviors to replace the use of negative ones, with an emphasis on self-talk, critical thinking, as well as talking about the problem vs. acting out behaviorally.

Of course it is very important that we utilize a team based approach and involve all the professionals involved in the child’s care including the child’s parents in order to ensure smooth and consistent carryover across all settings. Consistency is definitely a huge part of all behavior plans as it optimizes intervention results and achieves the desired therapy outcomes.

So the next time the client on your caseload is acting out don’t be so hasty in judging their behavior, when you have no idea regarding the reasons for it. Troubleshoot using appropriate and relevant steps in order to figure out what is REALLY going on and then attempt to change the situation in a team-based, systematic way.

For more detailed information on the topic of social pragmatic language assessment and behavior management in speech pathology see if the following Smart Speech Therapy LLC products could be of use:

References:

Bobrow, A. (2002). Problem behaviors in the classroom: What they mean and how to help. Functional Behavioral Assessment, 7 (2), 1–6.
Chandler, L.K., & Dahlquist, C.M. Functional assessment: strategies to prevent and remediate challenging behavior in school settings (2nd ed.). Upper Saddle River, New Jersey: Pearson Education, Inc.
Klein, H., & Moses, N. (1999). Intervention planning for children with communication disorders: A guide to the clinical practicum and professional practice. (2nd Ed.). Boston, MA.: Allyn & Bacon.
Kohn, A. (2001, Sept). Five reasons to stop saying “good job!’. Young Children. Retrieved from http://www.alfiekohn.org/parenting/gj.htm

Posted on June 7, 2015January 5, 2022 by Tatyana Elleseff — Leave a comment

Friend or Friendly: What Does Age Have To Do with It?

In my social pragmatic language groups I target a wide variety of social communication goals for children with varying levels and degrees of impairment with a focus on improving their social pragmatic language competence. In the past I have written blog posts on a variety of social pragmatic language therapy topics, including strategies for improving students’ emotional intelligence as well as on how to teach students to develop insight into own strengths and weaknesses. Today I wanted to discuss the importance of teaching students with social communication impairments, age recognition for friendship and safety purposes.

Now it is important to note that the focus of my sessions is a bit different from the focus of “teaching protective behaviors”, “circles of intimacy and relationships” or “teaching kids to deal with tricky people“. Rather the goal is to teach the students to recognize who it is okay “to hang out” or be friends with, and who is considered to be too old/too young to be a friend.

Why is it important to teach age recognition?

There are actually quite a few reasons.

Firstly, it is a fairly well-known fact that in the absence of age-level peers with similar weaknesses, students with social communication deficits will seek out either much younger or much older children as playmates/friends as these individuals are far less likely to judge them for their perceived social deficits. While this may be a short-term solution to the “friendship problem” it also comes with its own host of challenges. By maintaining relationships with peers outside of their age group, it is difficult for children with social communication impairments to understand and relate to peers of their age group in school setting. This creates a wider chasm in the classroom and increases the risk of peer isolation and bullying.

Secondly, the difficulty presented by friendships significantly outside of one’s peer group, is the risk of, for lack of better words, ‘getting into trouble’. This may include but is not limited to exploring own sexuality (which is perfectly normal) with a significantly younger child (which can be problematic) or be instigated by an older child/adolescent in doing something inappropriate (e.g, shoplifting, drinking, smoking, exposing self to peers, etc.).

Thirdly, this difficulty (gauging people’s age) further exacerbates the students’ social communication deficits as it prevents them from effectively understanding such pragmatic parameters such as audience (e.g., with whom its appropriate to use certain language in a certain tone and with whom it is not) and topic (with whom it is appropriate to discuss certain subjects and with whom it is not).

So due to the above reasons I began working on age recognition with the students (6+ years of age) on my caseload diagnosed with social communication and language impairments. I mention language impairments because it is very important to understand that more and more research is coming out connecting language impairments with social communication deficits. Therefore it’s not just students on the autism spectrum or students with social pragmatic deficits (an official DSM-5 diagnosis) who have difficulties in the area of social communication. Students with language impairments could also benefit from services focused on improving their social communication skills.

I begin my therapy sessions on age recognition by presenting the students with photos of people of different ages and asking them to attempt to explain how old do they think the people in the pictures are and what visual clues and/or prior knowledge assisted them in the formulation of their responses. I typically select the pictures from some of the social pragmatic therapy materials packets that I had created over the years (e.g., Gauging Moods, Are You Being Social?, Multiple Interpretations, etc.).

I make sure to carefully choose my pictures based on the student’s age and experience to ensure that the student has at least some degree of success making guesses. So for a six-year-old I would select pictures of either toddlers or children his/her age to begin teaching them recognition of concepts: “same” and “younger” (e.g., Social Pragmatic Photo Bundle for Early Elementary Aged Children).

For older children, I vary the photos of different aged individuals significantly. I also introduce relevant vocabulary words as related to a particular age demographic, such as:

Infant (0-1 years of age)
Toddler (2-3 years of age)
Preschooler (3-5 years of age)
Teenager (individual between 13-19 years of age)
Early, mid and late 20s, 30s, 40s
Middle-aged (individuals around 50 years of age)
Senior/senior citizen (individuals ~65+ years of age)

I explain to the students that people of different ages look differently and teach them how to identify relevant visual clues to assist them with making educated guesses about people’s ages. I also use photos of my own family or ask the students to bring in their own family photos to use for age determination of people in the presented pictures. When students learn the ages of their own family members, they have an easier time determining the age ranges of strangers.

My next step is to explain to students the importance of understanding people’s ages. I present to the students a picture of an individual significantly younger or older than them and ask them whether it’s appropriate to be that person’s friend. Here students with better developed insight will state that it is not appropriate to be that person’s friend because they have nothing in common with them and do not share their interests. In contrast, students with limited insight will state that it’s perfectly okay to be that person’s friend.

This is the perfect teachable moment for explaining the difference between “friend” and “friendly”. Here I again reiterate that people of different ages have significantly different interests as well as have significant differences in what they are allowed to do (e.g., a 16-year-old is allowed to have a driver’s permit in many US states as well as has a later curfew while an 11-year-old clearly doesn’t). I also explain that it’s perfectly okay to be friendly and polite with older or younger people in social situations (e.g., say hello all, talk, answer questions, etc.) but that does not constitute true friendship.

I also ask students to compile a list of qualities of what they look for in a “friend” as well as have them engage in some perspective taking (e.g, have them imagine that they showed up at a toddler’s house and asked to play with him/her, or that a teenager came into their house, and what their parents reaction would be?).

Finally, I discuss with students the importance of paying attention to who wants to hang out/be friends with them as well as vice versa (individuals they want to hang out with) in order to better develop their insight into the appropriateness of relationships. I instruct them to think critically when an older individual (e.g, young adult) wants to get particularly close to them. I use examples from an excellent post written by a colleague and good friend, Maria Del Duca of Communication Station Blog re: dealing with tricky people, in order to teach them to recognize signs of individuals crossing the boundary of being friendly, and what to do about it.

So there you have it. These are some of the reasons why I teach age recognition to clients with social communication weaknesses. Do you teach age recognition to your clients? If so, comment under this post, how do you do it and what materials do you use?

Helpful Smart Speech Resources Related to Assessment and Treatment of Social Pragmatic Disorders

Posted on July 31, 2013January 5, 2022 by Tatyana Elleseff — Leave a comment

Trivia Night Answers and Winners

Thank you all who participated in yesterday’s Trivia Night!

Below you’ll find answers to round’s questions as well as the names of winners for each round.

Round 1: Early Child Development

1. Name at least 3 characteristics of child directed speech

These include: motherese, repetition, modeling speech, simple syntax, slowing rate, using a higher pitch as well as using an exaggerated intonation pattern.

2. What is the critical period hypothesis? It is a time period during which language acquisition takes place

3. Name at least 3 functions of communicative behavior during infancy

These include: obtaining attention, seeking approval, seeking assistance, seeking attachment just to name a few

4. Name 2 types of echolalia: Immediate and Delayed

5. What is jargon and up until what age is it appropriate in children? Jargon is not true speech but rather pre-linguistic “nonsensical” vocalizations which involve adult-like stress and intonation patterns. Jargon usually begins to occur around 10-11 months of age in children and can typically last up until about 18 months of age give or take depending on the individual development rate of the child in question.

Round 2: Internationally Adopted Children

1. As related to internationally adopted (IA) children, what does the acronym CLM stand for and what does it mean?

CLM stands for Cognitive Language Mastery. It is the language needed for formal academic learning. This includes listening, speaking, reading, and writing about subject area content material including analyzing, synthesizing, judging and evaluating presented information. This level of language learning is essential for a child to succeed in school. CLM typically takes years and years to master, especially because, IA children did not have the same foundation of knowledge and stimulation as bilingual children in their birth countries.

2. ”The pattern of language acquisition in internationally adopted children is often referred to as a second first language acquisition” (Scott et al., 2011). Why? Because the first language (which is typically delayed and limited to begin with due to adverse effects of institutionalization) becomes completely obsolete as English is learned. So they end up learning L2 literally from scratch.

3. Why CAN’T we treat Internationally Adopted children as bilingual speakers? Because they are typically adopted by parents who do not speak their birth language as a result of which they experience rapid birth language attrition and forget their birth language very rapidly.

4. IA children may present with “normal” language abilities but still display significant difficulties in this area of functioning cognitive-academic and or social pragmatic communication (acceptable responses).

5. Finish the following sentence: “Any child with a known history of speech and language delays in the sending country should be considered to have true delays or disorders and should receive speech and language services after adoption.” (Glennen, 2009, p.52)

Round 3: Fetal Alcohol Spectrum Disorders

1. FASD is an umbrella term for the range of effects that can occur due to maternal alcohol consumption during pregnancy which may create physical, cognitive, behavioral, as well as learning/language deficits. It is NOT a clinical diagnosis. Please list at least 3 CURRENT terms under the FASD umbrella (see http://depts.washington.edu/fasdpn/htmls/fasd-fas.htm for details)

Fetal Alcohol Syndrome (FAS)
Partial FAS
Static Encephalopathy (alcohol exposed)
Neurobehavioral Disorder (alcohol exposed)

2. Name at least 3 characteristics of infants/toddlers with alcohol related deficits

May show failure to thrive
Increased sensitivity to sensory stimuli
Delayed speech/language milestones
Decreased muscle tone and poor muscle coordination
Poor self regulation

3. Since behavioral problems become more pronounced during the school years, many researchers found that the primary deficit of school aged children with FASD is in the area of (acceptable responses below)

Daily Functioning Skills
Self-regulation difficulties
Problem Solving Issues
Social/emotional problems

4. Finish the following sentence: adolescents with FASD have significant DIFFICULTY LEARNING FROM Experience

5. Why is early detection of alcohol related deficits important? Because it can lead to

Early and Appropriate Service Delivery
Improved Adaptability
Improved Functioning
Improved Outcomes

AND NOW THE WINNERS:

Round 1: Kristin Yanchuleff Simmons

Round 2: Christina Pillar Cook

Round 3: Kristin Yanchuleff Simmons

Search Results for:  http:/www.smartspeechtherapy.com/shop/fetal-alcohol-spectrum-disorders-assessment-and-treatment-bundle

SLPs Blogging About Research: August Edition -FASD

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Trivia Night Answers and Winners

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